A bill introduced just over a week ago seeks to eliminate the Health Insurance Administration (PRHIA), the entity entrusted with managing and overseeing the Health Reform. The functions, duties, and responsibilities of the public corporation would go to the Health Secretary through the creation of what would be the Health Insurance Administration Program.
Senate President Thomas Rivera Schatz introduced the measure by petition. Sources said the federal government requested this as a condition to financing the reform. Senate Bill 1437 was referred to the Senate Health Committee, chaired by Senator Ángel "Chayanne" Martínez.
El Nuevo Día learned that the measure - which was filed on Oct. 24 - is scheduled to be discussed in public hearings in two weeks.
"This requires a lot of work, but if we want to receive the money (from the federal government), we have to do it," said Dr. Víctor Ramos, president of the College of Physicians and Surgeons of Puerto Rico.
Yolanda García is currently the head of PRHIA on an interim basis after the FBI arrested Ángela Ávila last July. Fernando Scherrer Caillet, an executive at the BDO Puerto Rico auditing firm, as well as consultant Alberto Velázquez Piñol, were also arrested by the FBI in that federal operation.
After the arrests, former Chief of Staff Ricardo Llerandi asked the Inspector General's Office to audit the contracts of the government's Health Plan insurers.
According to Ramos, the federal government expressed surprise over the fact it is not the Health Department the entity that files funds requests, through Medicaid, to the federal agency.
Created in 1993, PRHIA is the public corporation responsible for implementing, managing, and negotiating contracts with insurers and health care organizations for an insurance system designed to eventually provide health care access to all the island´s residents.
"It's a two-headed monster. On one hand, there's PRHIA and on the other, Medicaid (at the Department of Health). It makes no sense. Sometimes they don't even communicate, they don't talk (to each other)," the pediatrician said.
He also warned that this measure allows rethinking the health system and steps to try to correct several of the conflicts that arose from the Reform.
"I have doubts about this measure," said Juan Oscar Morales, chairman of the House Health Committee.
According to Morales, the Health Department hired a company to evaluate this change, but that analysis has not yet been completed.
Even so, the representative said that when he arrives at the House he will open the way for it for and hold public hearings. He added that a big question that should be answered is whether there is a federal request for this change.
"I think there is an opportunity to do that consolidation," said Jaime Plá, executive president of the Puerto Rico Hospital Association.
According to Plá, this change could be done with most of the PRHIA staff because of their expertise in the Health Reform administration and management. In addition to savings, Plá said this change could also help strengthen credibility with the federal government.
"The government has to determine if they continue with the insurers (managing the health reform system) or if they start with the single-payer system. It would be a good opportunity to conduct that study," he said.
He added that one of his concerns over the measure is that they implement this just to address the federal government's concern, instead of taking the opportunity to improve Medicaid administration.
Meanwhile, José Sanchez, of the Clinical Laboratories Association, said that the creation of this program requires the participation of all sectors involved, both the government and the suppliers themselves.
"We need a special law and the participation of all sectors," he said.
It was not possible to get a reaction from Rivera Schatz or Senator Martínez. However, El Nuevo Día learned that they had already asked several organizations and experts about the proposal.